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Does size matter concerning impact of position on oxygenation status in spontaneously breathing patients with unilateral effusion?
  1. Stylianos A Michaelides1,
  2. Avgerinos-Romanos Michailidis1,2,
  3. George D Bablekos2,
  4. Antonis Analitis3,
  5. Maria Michalatou4,
  6. Nikolaos Koulouris5
  1. 1Department of Occupational Lung Diseases and Tuberculosis, Sismanogleio-Amalia Fleming General Hospital, Athens, Greece
  2. 2Department of Medical Laboratories, Faculty of Health and Caring Professions, University of Applied Sciences / Technological Educational Institute (TEI) of Athens, Athens, Greece
  3. 3Department of Hygiene, Epidemiology and Medical Statistics, Medical School National and Kapodistrian University of Athens, Athens, Greece
  4. 4Department of Physiotherapy, Sismanogleio-Amalia Fleming General Hospital, Athens, Greece
  5. 5First Department of Thoracic Medicine, Medical School, National and Kapodistrian University of Athens, Hospital for Diseases of the Chest (Sotiria), Athens, Greece
  1. Correspondence to Dr George D Bablekos, Thoracic Surgeon, Androu 16B Str, Melissia 15127, Athens, Greece; gbableko{at}otenet.gr

Abstract

Background Inconsistent and contradictory findings have appeared in the literature concerning the impact of body position on oxygenation in pleural effusion.

Methods We attempted to elucidate whether the size of the pleural effusion in patients with no parenchymal disease is the main determinant of posture-induced alterations in oxygenation parameters. We studied 62 spontaneously breathing patients aged 65.3±7.8 years (mean±SD), of whom 36 had large and massive-sized effusions (Group A) and 26 had small and moderate-sized effusions (Group B). Arterial blood gases were determined in four different body positions: sitting (SIT), supine (SUP), ipsilateral (IPS) and contralateral (CON) to the effusion side, after remaining relaxed for at least 20 min in each position. Separation into groups A and B was deliberately set from the position of the fluid meniscus line on a posteroanterior chest film just above the upper costal margin of the sixth anterior rib. A two-way ANOVA model with outcome variables PaO2, PaCO2 and [A–a] DO2 was used.

Results In both groups the best oxygenation was found in SIT. The worst oxygenation (highest [A–a] DO2 value) occurred in group A in CON compared with IPS (59.4±7.6 vs 49.0±7.5 mm Hg, p<0.001) and in group B in IPS compared with CON (51.0±8.7 vs 39.5±9.2 mm Hg, p<0.001). Also, PaCO2 showed significant differences in both groups in IPS compared with CON (p=0.002).

Conclusions Patients with large-sized effusions exhibit the worst oxygenation when lying on the side contralateral to the effusion, while those with small-sized effusions exhibit the worst oxygenation when lying on the side ipsilateral to the effusion.

  • pleura
  • effusion
  • physiology
  • oxygenation
  • body position
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Footnotes

  • Contributors SAM: acquisition of data, drafting the manuscript, medical interpretation of data, writing of the manuscript, revision and final approval. A-RM: acquisition of data, drafting the manuscript, medical interpretation of data, writing of the manuscript, revision and final approval. GDB: acquisition of data, drafting the manuscript, medical interpretation of data, writing of the manuscript, revision and final approval. AA: drafting the manuscript, medical statistics, writing of the manuscript, revision and final approval. MM: drafting the manuscript, medical interpretation of the data, writing of the manuscript, revision and final approval. NK: drafting the manuscript, medical interpretation of the data, writing of the manuscript, revision and final approval.

  • Competing interests None declared.

  • Ethics approval Ethics committee of Sismanogleion General Hospital, Athens, Marousi, Greece. National and Kapodistrian University of Athens.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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